Stroke Risk After COVID-19 Bivalent Vaccination Among US Older Adults is a study just published in the Journal of the American Medical Association. It examined the risk of stroke in a time period immediately after administration of either brand of a COVID-19 bivalent vaccine compared with a later time period among adults aged 65 years or older. The authors conclude that “in this self-controlled case series that included 11 001 Medicare beneficiaries who experienced stroke after administration of either brand of the COVID-19 bivalent vaccine, the risk of stroke was not significantly elevated during the 1- to 21-day or 22- to 42-day risk window after vaccination compared with the 43- to 90-day control window.”

Sounds good. But buried inside the report is this: “A statistically significant association between receipt of the COVID-19 bivalent BNT162b2; WT/OMI BA.4/BA.5 vaccine and nonhemorrhagic stroke was observed in the age group of 85 years or older during the 1- to 21-day risk window after vaccination. “And this: In the age group of 85 years or older, the association between receipt of a high-dose or adjuvanted influenza vaccine and a stroke outcome was observed for nonhemorrhagic stroke during the 22- to 42-day risk window after vaccination.”

That the statistically significant increase in nonhemorrhagic strokes in 85 year olds is not mentioned in the abstract, discussion, or conclusions is odd if not upsetting. When the 85 year old subjects are combined with those younger there is no significant increase in strokes. But if a doctor’s patient is 85 years old or more he/she might decide to forgo vaccination against either COVID or flu.

Two maxims are applicable here. First, do no harm. And that the purpose of medicine is to prevent premature death and relieve pain and suffering. If this report is reproducible, the desirability of administering either vaccine to the very old should be questioned. Also, the JAMA should make important information a little easier to find. Most physicians read only the abstract of most of the articles they view. There just isn’t enough time to read the entirety of most articles that are seen.